Consulting Success Stories

Home and Community Care: An Integral Part of Trinidad and Tobago’s National Oncology Programme

The initiative: The Government of the Republic of Trinidad and Tobago is establishing the National Oncology Programme (NOP) to enhance the country’s cancer care services. In addition to building a National Oncology Centre (NOC) a key element of this initiative is the NOP’s Community and Home Support Programme (CHSP).

Following a needs assessment that supported the NOP’s Supportive Care Subcommittee decision to focus first on palliative and acute care services, the CHSP design work began in June 2005. Working in a small, stepwise way, the palliative pilot was launched in one geographical area in November 2005. Learning from the experience and expanding the programme development activity outside this initial Region, the acute pilot admitted its first client in January 2007. Since that time and through ongoing education, sharing, coaching and support, the pilot activity has since spread to all five Regions in the country and four of the five had taken on their first clients by April 2007.

Within and beyond the NOP, the value of home care in supporting primary health care reform, easing pressures on facility-based care and bringing evidence-based care closer to home is already recognized.

Saint Elizabeth Health Care's role: SEHC worked with the Ministry and the Regional Health Authorities (RHAs) for more than two years to support the development and testing of the new CHSP. The work included providing education and developing processes, tools and the environment to support the pilot teams in moving forward. The education was operationally and clinically focussed and included orientation and ongoing education to support initial transition and adjustment as actual experience was gained.

SEHC became part of local, regional and national teams, supporting a variety of areas – sensitization of health care partners, development of a quality programme, creation of business plans and much more. It was important to identify the barriers and enablers to quality health care rather than focusing solely on more specific, direct tasks required to begin to build the CHSP. As well as challenges specific to individual organizations, we worked together to address system-wide issues that impacted the NOP’s CHSP and other health care initiatives as Trinidad and Tobago advances the achievement of its vision of primary care reform and excellence in client care.

Our intent was, and always is to support local capacity and talent, coaching at various levels and sharing the work to develop solutions in any areas affecting quality and sustainability, gradually becoming less involved as the local teams become comfortable and confident in their new roles.

Next steps: The intent of all Regions and the NOP is to move from pilot to programme status, stability and capacity. Fundamental to moving forward is commitment, incredible passion and a pioneering spirit by health care teams and their leaders, at various levels – a spirit that is thriving. Other keys to success are building a solid foundation of evidence-based practice and optimal resource allocation; providing ongoing Regional support to enable the expansion; and establishing national initiatives to promote sustainability and consistency of the CHSP throughout Trinidad and Tobago.